Diseases of the Retina — MCQs

Diseases of the Retina Indian Medical PG Practice Questions and MCQs

Question 621: Fluorescein dye study is done to detect:

A. Retinal vascular pathology (Correct Answer)
B. Posterior segment of eye
C. Assess retinal vascular conditions in babies
D. Macular vascular pathology

Explanation: ***Retinal vascular pathology*** - **Fluorescein angiography** is a diagnostic procedure using a fluorescent dye to visualize and study blood flow in the **retinal blood vessels**. - It helps detect and characterize various retinal vascular conditions like **diabetic retinopathy**, **retinal vein occlusions**, and **macular edema**. *Assess retinal vascular conditions in babies* - While fluorescein angiography can be performed in babies, it's generally avoided due to the need for sedation and potential risks, making it less routine than for adult retinal conditions. - The primary purpose is broader than just babies; it's used across all age groups where retinal vascular pathology is suspected. *Macular vascular pathology* - **Macular vascular pathology** is a specific type of retinal vascular pathology, but the dye study assesses the entire retinal vasculature, not just the macula. - Focusing solely on the macula would be an incomplete description of the widespread utility of fluorescein angiography. *Posterior segment of eye* - The **posterior segment** includes structures beyond just the retina, such as the choroid and optic nerve. - While fluorescein angiography provides some information about choroidal circulation, its primary and most detailed application is for evaluating the **retinal vasculature**.

Question 622: Treatment of choice for clinically significant macular edema in a diabetic is?

A. Intravitreal anti-VEGF injections (Correct Answer)
B. Control of Diabetes
C. Panretinal Photocoagulation
D. Focal Photocoagulation

Explanation: ***Intravitreal anti-VEGF injections*** - **Anti-VEGF agents** (e.g., ranibizumab, aflibercept) are the first-line treatment for **clinically significant diabetic macular edema (DME)** as they effectively reduce vascular leakage and improve vision. - They target **vascular endothelial growth factor (VEGF)**, a key mediator of increased vascular permeability and neovascularization in diabetic retinopathy. *Control of Diabetes* - While essential for preventing the **progression of diabetic retinopathy** and overall health, it is not the primary direct treatment for *existing* clinically significant macular edema. - Good glycemic control can reduce the *risk* of developing DME but does not acutely resolve established edema. *Panretinal Photocoagulation* - **Panretinal photocoagulation (PRP)** is primarily used for **proliferative diabetic retinopathy (PDR)** to ablate ischemic retina and reduce neovascularization. - It is not the treatment of choice for macular edema, as it can sometimes worsen macular function and visual acuity due to treatment-induced damage. *Focal Photocoagulation* - **Focal laser photocoagulation** was historically used for DME, targeting discrete leaking microaneurysms. - While effective for specific focal leakage, it has largely been superseded by **anti-VEGF injections** due to their superior efficacy in diffuse edema and better visual outcomes, especially when edema involves the fovea.

Question 623: All are seen in non-proliferative diabetic retinopathy except which of the following?

A. Microaneurysm
B. Neovascularization (Correct Answer)
C. Cotton wool spots
D. Retinal hemorrhages

Explanation: ***Neovascularization*** - **Neovascularization** signifies the growth of new, fragile blood vessels and is a hallmark feature of **proliferative diabetic retinopathy**, not non-proliferative. - These new vessels can bleed, leading to vitreous hemorrhage and tractional retinal detachment, which are severe complications. *Microaneurysm* - **Microaneurysms** are the earliest clinical sign of diabetic retinopathy, visible as small, red dots on funduscopic examination due to capillary outpouchings. - They are characteristic findings in **non-proliferative diabetic retinopathy (NPDR)**. *Cotton wool spots* - **Cotton wool spots** are soft exudates resulting from microinfarcts in the retinal nerve fiber layer due to occluded precapillary arterioles. - They are findings commonly seen in **non-proliferative diabetic retinopathy (NPDR)**. *Retinal hemorrhages* - **Retinal hemorrhages** (dot-blot hemorrhages) occur when blood leaks from damaged capillaries in the retina. - They are a common occurrence in **non-proliferative diabetic retinopathy (NPDR)**.

Question 624: First retinal abnormality in diabetic retinopathy is

A. Microaneurysm (Correct Answer)
B. Hard exudates
C. Soft exudates
D. Flame-shaped hemorrhages

Explanation: ***Microaneurysm*** - **Microaneurysms** are the **earliest clinically detectable lesions** in diabetic retinopathy, forming as out-pouchings of weakened capillary walls. - They are typically seen as **small, red dots** on funduscopic examination and indicate initial capillary damage. *Hard exudates* - **Hard exudates** represent **lipid and lipoprotein deposits** and indicate leakage from damaged capillaries, usually appearing later than microaneurysms. - They are typically **yellow-white, shiny lesions** with distinct margins, often found in a circinate pattern around leaking vessels. *Soft exudates* - **Soft exudates**, also known as **cotton wool spots**, are microinfarctions of the retinal nerve fiber layer due to capillary occlusion, indicating more severe ischemia. - They appear as **fluffy, white patches** with indistinct borders and are generally a sign of more advanced retinopathy. *Flame-shaped hemorrhages* - **Flame-shaped hemorrhages** occur in the **nerve fiber layer** and typically indicate superficial retinal bleeding, often associated with hypertension. - While common in diabetic retinopathy, they are not the *first* abnormality, as microaneurysms precede them in the disease progression.

Question 625: A young patient presents to the ophthalmology clinic with loss of central vision. The electroretinogram (ERG) is normal, but the electrooculogram (EOG) is abnormal. Which of the following is the most likely diagnosis?

A. Stargardt's disease
B. Best's vitelliform dystrophy (Correct Answer)
C. Retinitis pigmentosa
D. Cone-rod dystrophy

Explanation: ***Best's vitelliform dystrophy*** - This condition is characterized by an **abnormal electrooculogram (EOG)** with a normal electroretinogram (ERG). - It primarily affects the retinal pigment epithelium (**RPE**) and leads to **central vision loss** due to macula degeneration. *Stargardt's disease* - Patients typically present with **central vision loss** and a normal ERG, but the **EOG is also normal**, distinguishing it from Best's. - It is caused by mutations in the **ABCA4 gene** and results in progressive macular degeneration. *Retinitis pigmentosa* - This is a progressive degeneration of the **retina's photoreceptors**, leading to **night blindness** and **peripheral vision loss**. - Both the **ERG and EOG are typically abnormal**, reflecting widespread retinal dysfunction. *Cone-rod dystrophy* - This condition is also characterized by progressive **photoreceptor degeneration**, but primarily affecting **cones** more than rods initially, leading to central vision loss and color vision abnormalities. - Both **ERG and EOG would typically be abnormal**, showing reduced cone and rod responses.

Question 626: Condition where subhyaloid hemorrhage is associated with subarachnoid hemorrhage is what?

A. Posner-Schlossman syndrome
B. Pseudoexfoliation syndrome
C. Terson's syndrome (Correct Answer)
D. Axenfeld-Rieger syndrome

Explanation: ***Terson's syndrome*** - Terson's syndrome is characterized by **intraocular hemorrhage** (e.g., vitreous, subhyaloid, preretinal hemorrhage) associated with **subarachnoid hemorrhage**. - The presumed mechanism involves a sudden increase in **intracranial pressure (ICP)** during subarachnoid hemorrhage, leading to rupture of retinal capillaries or venules. *Posner-Schlossman syndrome* - This syndrome is a recurrent, unilateral **nongranulomatous anterior uveitis** associated with **elevated intraocular pressure**. - It is not directly associated with subarachnoid hemorrhage or subhyaloid bleeding. *Axenfeld-Rieger syndrome* - This is a rare, **autosomal dominant developmental disorder** affecting the anterior segment of the eye, often associated with systemic anomalies. - It can lead to **glaucoma** but does not involve subhyaloid hemorrhage linked to subarachnoid hemorrhage. *Pseudoexfoliation syndrome* - This condition is characterized by the production and deposition of an **extracellular fibrillar material** throughout the anterior segment of the eye. - It is a significant risk factor for **pseudoexfoliation glaucoma** and cataract formation but has no association with subarachnoid hemorrhage.

Question 627: What is the most likely diagnosis based on the findings of a fundus examination showing swelling of the optic disc?

A. Papillitis
B. Papilledema (Correct Answer)
C. Cupping of the disk
D. Silver wire appearance

Explanation: **Papilledema** - **Papilledema** is defined as **swelling of the optic disc** due to increased **intracranial pressure** transmitted along the optic nerve sheath. - This condition is typically **bilateral** and is an important sign of underlying neurological pathology requiring urgent investigation. *Papillitis* - **Papillitis** is a form of **optic neuritis** where inflammation affects the optic nerve head, causing **unilateral vision loss** and optic disc swelling. - Unlike papilledema, papillitis is primarily an inflammatory process of the optic nerve itself, not necessarily caused by increased intracranial pressure. *Cupping of the disk* - **Cupping of the optic disc** refers to the enlargement and excavation of the central optic disc, which is characteristic of **glaucoma** due to progressive retinal ganglion cell loss. - This is a sign of nerve fiber layer damage and elevated intraocular pressure, distinctly different from optic disc swelling. *Silver wire appearance* - A **silver wire appearance** refers to the severe narrowing and sheathing of retinal arterioles, often seen in cases of **hypertensive retinopathy** or other severe retinal vascular diseases. - This finding indicates chronic vascular damage and is not associated with optic disc swelling.

Question 628: Which of the following is NOT a feature of Fuchs' Heterochromic Uveitis?

A. Heterochromia
B. Rubeosis iridis
C. Stellate Keratic precipitate
D. Posterior Synechiae (Correct Answer)

Explanation: ***Posterior Synechiae*** - Posterior synechiae, which are **adhesions between the iris and the lens**, are notably absent in Fuchs' heterochromic uveitis. - This is because Fuchs' uveitis is characterized by a **mild, non-granulomatous inflammation** that does not typically lead to the formation of such adhesions. - The **absence of posterior synechiae** is a key distinguishing feature from other forms of chronic anterior uveitis. *Heterochromia* - **Heterochromia** (difference in iris color between the two eyes) is the **defining clinical feature** of this condition and gives it its name. - The affected eye typically shows a **lighter iris color** due to stromal atrophy and loss of pigment. - This feature is present in the majority of cases, though it may be subtle and sometimes only detected on careful examination. *Rubeosis iridis* - **Rubeosis iridis**, or the **formation of fine new blood vessels on the iris surface**, is a characteristic feature of Fuchs' heterochromic uveitis. - These fragile new vessels can lead to **spontaneous hyphema** (blood in the anterior chamber), particularly during intraocular surgery or paracentesis. *Stellate Keratic precipitate* - **Stellate keratic precipitates** (KPs), which are **small, star-shaped deposits** on the corneal endothelium, are a characteristic feature. - These KPs are **fine, diffuse, and scattered** over the entire corneal endothelium, unlike the larger, greasy KPs seen in granulomatous uveitis.

Question 629: A 2-year-old child presents with unilateral leukocoria and poor vision. What is the most likely diagnosis?

A. Congenital cataract
B. Retinoblastoma (Correct Answer)
C. Endophthalmitis
D. Coats disease

Explanation: ***Retinoblastoma*** - **Leukocoria** (white pupillary reflex) is the **most common presenting sign** of retinoblastoma, occurring in approximately 60% of cases - The combination of **unilateral leukocoria** and **poor vision** in a **2-year-old child** (peak age 18-24 months) is highly suggestive - It is a **rapidly growing malignant intraocular tumor** arising from the neural retina, requiring urgent evaluation and treatment - Other presenting features may include **strabismus**, **red eye**, and in advanced cases, **proptosis** *Congenital cataract* - Can also present with **leukocoria** due to opacification of the lens - However, congenital cataracts are typically **bilateral** (75% of cases) and diagnosed earlier in infancy - The **static, non-progressive nature** distinguishes it from the rapidly growing retinoblastoma - Family history and associated systemic conditions (TORCH infections, metabolic disorders) are common *Endophthalmitis* - Severe **intraocular infection** affecting vitreous and aqueous humor - Typically presents with **acute pain**, **severe redness**, **hypopyon**, and **rapid vision loss** - Usually follows **penetrating trauma** or **intraocular surgery**, which would be uncommon in a 2-year-old - **Leukocoria without acute inflammatory signs** makes this diagnosis unlikely *Coats disease* - Characterized by **abnormal telangiectatic retinal vessels** with **exudative retinal detachment** and **yellow subretinal exudates** - Can present with leukocoria (yellow reflex due to lipid deposits) in young children - However, it typically affects **older children** (mean age 5-8 years), is predominantly **unilateral**, and has a **more indolent course** - More common in **males** and usually lacks the rapid progression of retinoblastoma

Question 630: Which of the following features is characteristic of familial retinoblastoma?

A. Autosomal recessive inheritance
B. Mutation in the RB gene
C. Bilateral occurrence (Correct Answer)
D. Higher incidence than sporadic retinoblastoma

Explanation: ***Bilateral occurrence*** - Familial retinoblastoma is characterized by **bilateral involvement** of the eyes in approximately 60-70% of cases, as the inherited germline mutation in the **RB1 gene** predisposes both retinas. - The presence of the germline mutation means that every cell in the body carries the predisposition, increasing the likelihood of multiple primary tumor events, often in both eyes. - **Bilaterality** is the key **clinical characteristic** that distinguishes familial from sporadic retinoblastoma (which is typically unilateral). *Autosomal recessive inheritance* - Retinoblastoma, including familial forms, typically follows an **autosomal dominant inheritance pattern** with incomplete penetrance (~90%), not autosomal recessive. - A single mutated copy of the **RB1 gene** inherited from a parent is sufficient to predispose individuals to the disease. *Mutation in the RB gene* - While **germline mutation in the RB1 gene** is indeed present in familial retinoblastoma (and somatic mutations occur in sporadic forms), the question asks for a *characteristic feature* that distinguishes familial from sporadic forms. - Both familial and sporadic retinoblastoma involve RB1 gene dysfunction, but the **clinical presentation** (bilateral vs. unilateral), **age of onset** (earlier in familial), and **heritability** are the distinguishing features, not simply the presence of an RB1 mutation. - The hallmark clinical characteristic is **bilaterality**, not just the genetic mutation. *Higher incidence than sporadic retinoblastoma* - Familial retinoblastoma accounts for only a **smaller proportion** (about 25-40%) of all retinoblastoma cases. - **Sporadic retinoblastoma** (non-heritable, de novo somatic mutation) is actually more common, comprising 60-75% of all cases.

Practice by Chapter

Retinal Anatomy and Physiology

Practice Questions

Age-Related Macular Degeneration

Practice Questions

Diabetic Retinopathy

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Retinal Vascular Diseases

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Retinal Detachment

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Hereditary Retinal Dystrophies

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Inflammatory Retinal Diseases

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Retinal Tumors

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Retinopathy of Prematurity

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Retinal Imaging Techniques

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Intravitreal Pharmacotherapy

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Vitreoretinal Surgery

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